Personalized therapy

个性化治疗
  • 文章类型: Journal Article
    背景:抗原加工机制(APM)在产生可被免疫系统识别和靶向的肿瘤特异性抗原中起关键作用。APM组分的适当功能对于在肿瘤细胞表面上呈递这些抗原是必不可少的。使免疫检测和破坏。在许多癌症中,APM的缺陷会导致免疫逃避,有助于肿瘤进展和不良的临床结果。然而,肉瘤中APM的状态没有得到很好的表征,限制了这些患者有效的免疫治疗策略的发展。
    方法:我们调查了在2001-2021年间手术的126例8种骨和软组织肉瘤患者。组织微阵列在每种情况下绘制11个特定区域。通过免疫组织化学确定APM蛋白的存在/不存在。使用贝叶斯网络。
    结果:所有研究的肉瘤在APM中都有一些缺陷。受损程度最低的成分是HLAI类亚基β2-微球蛋白和HLAII类。蛋白酶体LMP10亚基在平滑肌肉瘤(LMS)中存在缺陷,粘液样脂肪肉瘤(MLPS),去分化脂肪肉瘤(DDLPS),而在未分化多形性肉瘤(UPS)中,MHCI转运单元TAP2发生了改变,胃肠道间质瘤(GIST),和脊索瘤(CH)。在不同的肿瘤区域中,与高淋巴细胞浸润区相比,高等级区显示出不同的表达模式。还观察到患者水平的异质性。任何APM成分的丢失是LMS和DDLPS的远处转移(DM)和LMS的总生存期(OS)的预后。
    结论:肉瘤在APM组件中表现出高度缺陷,组织学和肿瘤区域之间存在差异。最常见的改变的APM成分是HLAI类亚基β2-微球蛋白,HLAI类亚基α(HC10),和MHCI运输单元TAP2。APM成分的丢失是DM和OS的预后,并且与LMS和DDLPS临床相关。本研究探讨了肉瘤的分子机制,丰富个性化的治疗方法。
    BACKGROUND: The antigen processing machinery (APM) plays a critical role in generating tumor-specific antigens that can be recognized and targeted by the immune system. Proper functioning of APM components is essential for presenting these antigens on the surface of tumor cells, enabling immune detection and destruction. In many cancers, defects in APM can lead to immune evasion, contributing to tumor progression and poor clinical outcomes. However, the status of the APM in sarcomas is not well characterized, limiting the development of effective immunotherapeutic strategies for these patients.
    METHODS: We investigated 126 patients with 8 types of bone and soft tissue sarcoma operated between 2001-2021. Tissue microarrays mapped 11 specific areas in each case. The presence/absence of APM protein was determined through immunohistochemistry. Bayesian networks were used.
    RESULTS: All investigated sarcomas had some defects in APM. The least damaged component was HLA Class I subunit β2-microglobulin and HLA Class II. The proteasome LMP10 subunit was defective in leiomyosarcoma (LMS), myxoid liposarcoma (MLPS), and dedifferentiated liposarcoma (DDLPS), while MHC I transporting unit TAP2 was altered in undifferentiated pleomorphic sarcoma (UPS), gastrointestinal stromal tumor (GIST), and chordoma (CH). Among different neoplastic areas, high-grade areas showed different patterns of expression compared to high lymphocytic infiltrate areas. Heterogeneity at the patient level was also observed. Loss of any APM component was prognostic of distant metastasis (DM) for LMS and DDLPS and of overall survival (OS) for LMS.
    CONCLUSIONS: Sarcomas exhibit a high degree of defects in APM components, with differences among histotypes and tumoral areas. The most commonly altered APM components were HLA Class I subunit β2-microglobulin, HLA Class I subunit α (HC10), and MHC I transporting unit TAP2. The loss of APM components was prognostic of DM and OS and clinically relevant for LMS and DDLPS. This study explores sarcoma molecular mechanisms, enriching personalized therapeutic approaches.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    临床前动物模型的建立和利用是癌症研究各个方面的关键方面。不可避免地有助于理解疾病的发生和发展机制,以及促进创新抗癌治疗方法的发展。这些模型已经成为基础研究和临床研究之间的重要桥梁,为临床研究提供多方面的支持。这项研究最初集中在建立临床前动物模型的重要性和好处,讨论不同类型的临床前动物模型和癌症研究的最新进展。然后深入研究癌症治疗,研究肿瘤不同发展阶段的特点和抗癌药物的开发。通过整合肿瘤标志和临床前研究,我们阐述了抗癌药物开发的路径,并为个性化的癌症治疗策略提供指导,包括合成致死方法和在该领域广泛采用的新药。最终,我们总结了选择临床前安全性实验的战略框架,为实验模式和临床前动物物种量身定制,并对临床前动物模型的前景和挑战进行了展望。这些模型无疑为癌症研究提供了新的途径,包括药物开发和个性化抗癌方案。然而,前面的道路仍然漫长而充满障碍。因此,我们鼓励研究人员坚持利用先进技术来完善临床前动物模型,从而赋予这些新兴范例以积极影响癌症患者的结果。
    The establishment and utilization of preclinical animal models constitute a pivotal aspect across all facets of cancer research, indispensably contributing to the comprehension of disease initiation and progression mechanisms, as well as facilitating the development of innovative anti-cancer therapeutic approaches. These models have emerged as crucial bridges between basic and clinical research, offering multifaceted support to clinical investigations. This study initially focuses on the importance and benefits of establishing preclinical animal models, discussing the different types of preclinical animal models and recent advancements in cancer research. It then delves into cancer treatment, studying the characteristics of different stages of tumor development and the development of anti-cancer drugs. By integrating tumor hallmarks and preclinical research, we elaborate on the path of anti-cancer drug development and provide guidance on personalized cancer therapy strategies, including synthetic lethality approaches and novel drugs widely adopted in the field. Ultimately, we summarize a strategic framework for selecting preclinical safety experiments, tailored to experimental modalities and preclinical animal species, and present an outlook on the prospects and challenges associated with preclinical animal models. These models undoubtedly offer new avenues for cancer research, encompassing drug development and personalized anti-cancer protocols. Nevertheless, the road ahead continues to be lengthy and fraught with obstacles. Hence, we encourage researchers to persist in harnessing advanced technologies to refine preclinical animal models, thereby empowering these emerging paradigms to positively impact cancer patient outcomes.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    近几十年来,治疗性癌症疫苗被认为是能够导致肿瘤消退的重要免疫治疗策略。在这些疫苗的开发中,新表位的鉴定起着关键作用,和不同的计算方法已经被提出和采用来指导和加速这一过程。在这种情况下,这篇综述确定并系统分析了最近发表在文献中的关于治疗性疫苗开发表位的计算预测的研究,概述关键步骤,以及相关程序的优势和局限性。在PRISMA扩展(PRISMA-ScR)之后进行了范围审查。在数据库中进行搜索(Scopus,PubMed,WebofScience,科学直接)使用关键词:新表位,表位,疫苗,预测,算法,癌症,和肿瘤。对2012年至2024年发表的49篇文章进行了综合分析。大多数已确定的研究集中在预测对实体瘤中的MHCI分子具有亲和力的表位,如肺癌。预测具有II类MHC亲和力的表位的开发相对不足。除了从高通量测序数据中预测新表位外,确定了其他步骤,例如新表位的优先排序和验证。Mutect2是最常用的变体调用工具,而NetMHCpan有利于新表位预测。人工/卷积神经网络是用于新表位预测的优选方法。为了优先考虑免疫原性表位,随机森林算法是最常用的分类算法。与新表位预测和优先级排序的计算模型相关的性能值很高;然而,大部分研究仍使用微生物组数据库进行培训。在55%的分析研究中验证了预测的新表位的体外/体内验证。确定了导致肿瘤成功缓解的临床试验,强调这种免疫治疗方法可以使这些患者受益。整合高通量测序,复杂的生物信息学工具,和严格的验证方法,通过体外/体内试验以及临床试验,基于肿瘤新表位的疫苗方法有望开发针对特定肿瘤癌症的个性化治疗性疫苗.
    Therapeutic cancer vaccines have been considered in recent decades as important immunotherapeutic strategies capable of leading to tumor regression. In the development of these vaccines, the identification of neoepitopes plays a critical role, and different computational methods have been proposed and employed to direct and accelerate this process. In this context, this review identified and systematically analyzed the most recent studies published in the literature on the computational prediction of epitopes for the development of therapeutic vaccines, outlining critical steps, along with the associated program\'s strengths and limitations. A scoping review was conducted following the PRISMA extension (PRISMA-ScR). Searches were performed in databases (Scopus, PubMed, Web of Science, Science Direct) using the keywords: neoepitope, epitope, vaccine, prediction, algorithm, cancer, and tumor. Forty-nine articles published from 2012 to 2024 were synthesized and analyzed. Most of the identified studies focus on the prediction of epitopes with an affinity for MHC I molecules in solid tumors, such as lung carcinoma. Predicting epitopes with class II MHC affinity has been relatively underexplored. Besides neoepitope prediction from high-throughput sequencing data, additional steps were identified, such as the prioritization of neoepitopes and validation. Mutect2 is the most used tool for variant calling, while NetMHCpan is favored for neoepitope prediction. Artificial/convolutional neural networks are the preferred methods for neoepitope prediction. For prioritizing immunogenic epitopes, the random forest algorithm is the most used for classification. The performance values related to the computational models for the prediction and prioritization of neoepitopes are high; however, a large part of the studies still use microbiome databases for training. The in vitro/in vivo validations of the predicted neoepitopes were verified in 55% of the analyzed studies. Clinical trials that led to successful tumor remission were identified, highlighting that this immunotherapeutic approach can benefit these patients. Integrating high-throughput sequencing, sophisticated bioinformatics tools, and rigorous validation methods through in vitro/in vivo assays as well as clinical trials, the tumor neoepitope-based vaccine approach holds promise for developing personalized therapeutic vaccines that target specific tumor cancers.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    在许多国家,常规进行导管原位癌(DCIS)的激素受体状态评估,由于激素受体阳性的DCIS患者有资格接受辅助抗激素治疗,旨在降低同侧和对侧乳腺癌的风险。尽管HER2基因扩增及其相关的HER2蛋白过表达构成了浸润性乳腺癌的主要预后和预测指标。其在DCIS的诊断和治疗中的应用不太简单.HER2免疫组织化学尚未常规进行,由于HER2阳性在DCIS生物学中的作用尚不清楚。尽管如此,最近的数据挑战了这种做法。这里,我们讨论了常规HER2评估对DCIS的价值.HER2阳性与DCIS等级密切相关:5个HER2阳性DCIS中约有4个表现出高度异型性。由于形态学DCIS分级容易出现观察者间的变异性,HER2免疫组织化学可以使分级更稳健。多项研究表明,HER2阳性DCIS与同侧复发风险之间存在关联,尽管目前尚不清楚这是否是为了整体,原位或侵入性复发。HER2阳性DCIS往往更大,涉及手术切缘的风险较高。HER2阳性DCIS患者从辅助放疗中获益更多:它大大降低了肿瘤切除术后局部复发的风险,不影响总生存率。在纯活检诊断的DCIS中HER2阳性与手术后浸润性癌的分期增加相关。因此,术前活检的HER2免疫组织化学可能为外科医生提供有用的信息,赞成更广泛的切除。考虑DCIS亚型依赖性治疗的时机似乎是正确的,包括对HER2阳性的DCIS患者进行适当的局部治疗和对激素受体阳性的降升级,HER2阴性DCIS患者。
    In many countries, hormone receptor status assessment of ductal carcinoma in situ (DCIS) is routinely performed, as hormone receptor-positive DCIS patients are eligible for adjuvant anti-hormonal treatment, aiming to reduce the ipsilateral and contralateral breast cancer risk. Although HER2 gene amplification and its associated HER2 protein overexpression constitute a major prognostic and predictive marker in invasive breast carcinoma, its use in the diagnosis and treatment of DCIS is less straightforward. HER2 immunohistochemistry is not routinely performed yet, as the role of HER2-positivity in DCIS biology is unclear. Nonetheless, recent data challenge this practice. Here, we discuss the value of routine HER2 assessment for DCIS. HER2-positivity correlates strongly with DCIS grade: around four in five HER2-positive DCIS show high grade atypia. As morphological DCIS grading is prone to interobserver variability, HER2 immunohistochemistry could render grading more robust. Several studies showed an association between HER2-positive DCIS and ipsilateral recurrence risk, albeit currently unclear whether this is for overall, in situ or invasive recurrence. HER2-positive DCIS tends to be larger, with a higher risk of involved surgical margins. HER2-positive DCIS patients benefit more from adjuvant radiotherapy: it substantially decreases the local recurrence risk after lumpectomy, without impact on overall survival. HER2-positivity in pure biopsy-diagnosed DCIS is associated with increased upstaging to invasive carcinoma after surgery. HER2 immunohistochemistry on preoperative biopsies might therefore provide useful information to surgeons, favoring wider excisions. The time seems right to consider DCIS subtype-dependent treatment, comprising appropriate local treatment for HER2-positive DCIS patients and de-escalation for hormone receptor-positive, HER2-negative DCIS patients.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Editorial
    暂无摘要。
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:个性化疾病模型对于评估患病细胞对治疗的反应至关重要,尤其是在创新生物疗法的情况下。细胞外囊泡(EV),细胞释放的纳米囊泡用于细胞间通讯,由于其重新编程靶细胞的能力而获得了治疗兴趣。我们在这里利用从患有类固醇抗性肾病综合征的儿童获得的尿足细胞作为模型,以测试源自肾祖细胞(nKPCs)的EV的治疗潜力。
    方法:从早产新生儿尿液中提取的nKPCs中分离出EV。对从肾病患者尿液中获得的三行尿足细胞和一行Alport综合征患者足细胞进行了表征,并用于评估响应nKPC-EV或各种药物的白蛋白通透性。在nKPC-EV处理后进行RNA测序以鉴定通常调节的途径。使用siRNA转染来证明SUMO1和SENP2参与通透性的调节。
    结果:用nKPC-EV治疗可显著降低所有类固醇耐药患者来源和Alport综合征来源足细胞的通透性。在不一致的情况下,足细胞似乎对标准药物治疗无反应,除了一行,与患者48个月时的临床反应一致。通过RNA测序,在nKPC-EV处理的遗传改变的足细胞中,通常只有两个基因上调:小泛素相关修饰因子1(SUMO1)和Sentrin特异性蛋白酶2(SENP2).SUMO1和SENP2下调增加足细胞通透性,证实了SUMO化途径的作用。
    结论:nKPCs作为一种有希望的非侵入性来源,对遗传功能障碍的足细胞具有潜在的治疗作用,通过SUMOylation的调制,足细胞狭缝膈肌蛋白稳定性的重要途径。我们的发现还表明开发非侵入性体外模型以筛选患者来源的足细胞上的再生化合物的可行性。
    BACKGROUND: Personalized disease models are crucial for evaluating how diseased cells respond to treatments, especially in case of innovative biological therapeutics. Extracellular vesicles (EVs), nanosized vesicles released by cells for intercellular communication, have gained therapeutic interest due to their ability to reprogram target cells. We here utilized urinary podocytes obtained from children affected by steroid-resistant nephrotic syndrome with characterized genetic mutations as a model to test the therapeutic potential of EVs derived from kidney progenitor cells (nKPCs).
    METHODS: EVs were isolated from nKPCs derived from the urine of a preterm neonate. Three lines of urinary podocytes obtained from nephrotic patients\' urine and a line of Alport syndrome patient podocytes were characterized and used to assess albumin permeability in response to nKPC-EVs or various drugs. RNA sequencing was conducted to identify commonly modulated pathways after nKPC-EV treatment. siRNA transfection was used to demonstrate the involvement of SUMO1 and SENP2 in the modulation of permeability.
    RESULTS: Treatment with the nKPC-EVs significantly reduced permeability across all the steroid-resistant patients-derived and Alport syndrome-derived podocytes. At variance, podocytes appeared unresponsive to standard pharmacological treatments, with the exception of one line, in alignment with the patient\'s clinical response at 48 months. By RNA sequencing, only two genes were commonly upregulated in nKPC-EV-treated genetically altered podocytes: small ubiquitin-related modifier 1 (SUMO1) and Sentrin-specific protease 2 (SENP2). SUMO1 and SENP2 downregulation increased podocyte permeability confirming the role of the SUMOylation pathway.
    CONCLUSIONS: nKPCs emerge as a promising non-invasive source of EVs with potential therapeutic effects on podocytes with genetic dysfunction, through modulation of SUMOylation, an important pathway for the stability of podocyte slit diaphragm proteins. Our findings also suggest the feasibility of developing a non-invasive in vitro model for screening regenerative compounds on patient-derived podocytes.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    5-氟尿嘧啶(5-FU)的血浆浓度受多种因素的影响,从而限制了其功效。目前基于体表面积(BSA)的治疗方案剂量与毒性增加有关,有时与药物暴露不足有关。
    该研究旨在开发一种体外检测方法,以监测5-氟尿嘧啶在癌症患者血液样本中的治疗效果,专注于药代动力学,以提高治疗精度。
    根据标准确定药物水平,质量控制,和使用蛋白质沉淀的实验样品,液-液萃取,并使用具有等度程序的C18分析柱进行分离。
    在EXP-1A中,5-氟尿嘧啶的平均浓度为1.15μg/ml;在EXP-1B中,它是1.16μg/ml,而在EXP-1C中,平均浓度为0.9μg/ml。含有DPD灭活剂和EXP-1C(没有DPD灭活剂)的实验样品之间的平均5-氟尿嘧啶浓度的百分比差异对于EXP-1A高21.5%,对于EXP-1B高0.68%。在实验的第二阶段,与不含DPD灭活剂的样品相比,含有DPD灭活剂的样品中5-氟尿嘧啶的总体稳定性优于24.5%.
    已开发出一种改进的提取技术,可准确测量血液中的5-氟尿嘧啶浓度,通过添加DPD灭活剂来保持其稳定性和浓度。
    UNASSIGNED: The plasma concentration of 5-Fluorouracil (5-FU) is affected by numerous factors, thereby limiting its efficacy. The current therapeutic regimen\'s doses based on body surface area (BSA) are linked to increased toxicity and sometimes inadequate drug exposure.
    UNASSIGNED: The study aims to develop an in-vitro assay to monitor 5-Fluorouracil\'s therapeutic efficacy in cancer patients\' blood samples, focusing on pharmacokinetics to improve therapy precision.
    UNASSIGNED: Drug levels were determined from standards, quality controls, and experimental samples using protein precipitation, liquid-liquid extraction, and separation using a C18 analytical column with an isocratic program.
    UNASSIGNED: In EXP-1A, the mean concentration of 5-Fluorouracil was 1.15 μg/ml; in EXP-1B, it was 1.16 μg/ml, while in EXP-1C, the mean concentration was 0.9 μg/ml. The percentage difference in mean 5-Fluorouracil concentration between the experiment sample containing a DPD inactivator and EXP-1C (without a DPD inactivator) was 21.5 % higher for EXP-1A and 0.68 % higher for EXP-1B. In the second phase of the experiment, the overall stability of 5-Fluorouracil in samples containing a DPD inactivator was 24.5 % superior compared to samples without a DPD inactivator.
    UNASSIGNED: A modified extraction technique has been developed to accurately measure 5-Flourouracil concentration in blood, preserving its stability and concentration by adding a DPD inactivator.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    2021年,Princesa医院大学临床药理部发起了PriME-PGx倡议(医院大学实施药理学遗传学的多学科倡议),以促进住院患者的药理学遗传学扩展。我们根据七个部门的具体需求建立了七个药物遗传学谱:肿瘤学,疼痛单元,神经精神病学,内科或传染病药,心脏病学,胃肠病学和免疫抑制剂。过去3年的经验反映了总共1421份报告(37.4%是肿瘤学概况),随着每年请求数量的逐渐增加。有了这个项目,我们的目标是扩大药物遗传学生物标志物的可用性和实用性,以实现避免药物不良反应和治疗失败的个性化治疗.
    [方框:见正文]。
    In 2021, the Clinical Pharmacology Department of Hospital Universitario de La Princesa launched the PriME-PGx initiative (Multidisciplinary Initiative of the Hospital Universitario de La Princesa for the Implementation of Pharmacogenetics) to promote the expansion of pharmacogenetics in hospitalized patients. We establish seven pharmacogenetic profiles based on the specific needs of seven departments: Oncology, Pain Unit, Neuropsychiatry, Internal or Infectious Medicine, Cardiology, Gastroenterology and Immunosuppressants. The experience of the last 3 years reflects a total of 1421 reports (37.4% being oncology profiles), with a gradual increase in the number of requests each year. With this project, we aim to expand the availability and utility of pharmacogenetic biomarkers to achieve personalised therapy that avoids adverse drug reactions and therapeutic failure.
    [Box: see text].
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    CRISPR技术的进步,改变游戏规则的实验研究,彻底改变了生命科学的各个领域,癌症研究。细胞死亡途径是癌细胞中最失调的途径之一,被认为是癌症发展的关键方面。几十年来,我们对安排程序性细胞死亡的机制的了解已经大大增加,归因于尖端技术的革命。CRISPR系统的英勇出现扩展了可用的筛选平台和基因组工程工具箱,以检测突变并创建精确的基因组编辑。在这种情况下,该系统对导致癌症发展和治疗抵抗的细胞死亡信号通路中突变的识别和靶向的精确能力是改变和加速个体化癌症治疗的吉祥选择.个性化癌症治疗的概念在于识别个体肿瘤及其微环境的分子特征,以提供具有最高可能结果和最小毒性的精确治疗。这项研究通过识别和靶向特定的细胞死亡途径来探索CRISPR技术在精确癌症治疗中的潜力。它显示了CRISPR在寻找与程序性细胞死亡有关的关键成分和突变方面的前景,使其成为靶向癌症治疗的潜在工具。然而,这项研究还强调了在未来研究中需要解决的挑战和局限性,以充分发挥CRISPR在癌症治疗中的潜力.
    Advancements in the CRISPR technology, a game-changer in experimental research, have revolutionized various fields of life sciences and more profoundly, cancer research. Cell death pathways are among the most deregulated in cancer cells and are considered as critical aspects in cancer development. Through decades, our knowledge of the mechanisms orchestrating programmed cellular death has increased substantially, attributed to the revolution of cutting-edge technologies. The heroic appearance of CRISPR systems have expanded the available screening platform and genome engineering toolbox to detect mutations and create precise genome edits. In that context, the precise ability of this system for identification and targeting of mutations in cell death signaling pathways that result in cancer development and therapy resistance is an auspicious choice to transform and accelerate the individualized cancer therapy. The concept of personalized cancer therapy stands on the identification of molecular characterization of the individual tumor and its microenvironment in order to provide a precise treatment with the highest possible outcome and minimum toxicity. This study explored the potential of CRISPR technology in precision cancer treatment by identifying and targeting specific cell death pathways. It showed the promise of CRISPR in finding key components and mutations involved in programmed cell death, making it a potential tool for targeted cancer therapy. However, this study also highlighted the challenges and limitations that need to be addressed in future research to fully realize the potential of CRISPR in cancer treatment.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    目的非霍奇金淋巴瘤(NHL)在经典霍奇金淋巴瘤(cHL)治疗的患者中作为继发性恶性肿瘤出现是一种罕见且具有挑战性的临床情况。NHL可以与cHL同步呈现,也可以在以后发展,顺序,治疗cHL后长达数年。两种淋巴瘤之间的关系尚不清楚,这些患者的管理没有明确的指南。我们希望对这一问题有更好的临床理解,因此本研究调查了继发性NHL的发生和临床特征。材料和方法在这项回顾性队列检查中,我们收集了在cHL治疗过程中或之后发生NHL的cHL病例。我们对样本进行了组织病理学修订,在样品质量较低的情况下,我们进行了分子检查以发现cHL和NHL之间的关联。我们进行了下一代基因组测序(NGS)和免疫球蛋白重链可变区基因(IgHV)克隆性测试。结果在2011年至2020年诊断的164例cHL患者队列中,6例患者在淋巴瘤复发或进展提示的再活检期间被确定为NHL。其中,5例患者被诊断为生发中心起源的弥漫性大B细胞淋巴瘤(后GCDLBCL),1例患者出现高级别B细胞淋巴瘤(HG-BCL)。NHL的表现在时间上有所不同:成功的cHL治疗后出现了三例,至少有18个月的完全缓解,而其他三名患者则面临原发性难治性cHL。值得注意的是,主要难治性病例没有表现出cHL和NHL之间的确认克隆关系,但NGS数据提出了一种情况下同步NHL的可能性。相比之下,在依次发生NHL的患者中,在一个病例中,IgHV基因的聚合酶链反应(PCR)检测证实了cHL和继发性DLBCL之间的克隆连接,而高度的形态学相似性表明在另一种情况下两种淋巴瘤之间存在潜在的克隆性。结论本研究表明,继发性NHL可能在cHL后同步和依次出现。我们的结果表明,与在诊断时未识别出不同淋巴瘤的序贯病例相比,同步NHL的预后较差。正如我们的数据显示,在某些情况下,在肿瘤细胞克隆进化过程中伴随着它们的突变,后来有额外的突变。在未来,基于下一代测序(NGS)的液体活检样本处理可以克服淋巴恶性肿瘤空间异质性造成的局限性.从长远来看,这种识别可能导致早期患者选择和替代治疗策略,最终导致治疗前景的改善。
    Objective Non-Hodgkin lymphoma (NHL) arising as a secondary malignancy in patients treated for classical Hodgkin lymphoma (cHL) is an infrequent and challenging clinical scenario. NHL can be presented synchronously with cHL or may develop later, sequentially, up to years after treatment for cHL. The relationship between the two lymphomas is unclear, and there are no clear guidelines for the management of these patients. We would like to find a better clinical understanding of this issue so this study investigates the occurrence and clinical characteristics of secondary NHL. Materials and methods In this retrospective cohort examination, we collected cHL cases when NHL occurred during or after the course of treating cHL. We performed the histopathologic revisions of the samples, and in every case where the quality of the sample was lower, we performed molecular examinations to find the association between cHL and NHL. We performed next-generation genome sequencing (NGS) and immunoglobulin heavy-chain variable region gene (IgHV) clonality testing. Results In a cohort of 164 cHL patients diagnosed between 2011 and 2020, six patients were identified with NHL during rebiopsy prompted by lymphoma relapse or progression. Among these, five patients were diagnosed with post-germinal center-originated diffuse large B-cell lymphoma (post-GC DLBCL), and one patient presented high-grade B-cell lymphoma (HG-BCL). The NHL manifestation differed in its timing: three cases emerged after successful cHL treatment, with at least 18 months of complete remission, while the other three patients faced primary refractory cHL. Notably, the primary refractory cases did not exhibit a confirmed clonal relationship between cHL and NHL, but NGS data raised the possibility of synchronous NHL in one case. In contrast, among the patients with sequentially occurring NHL, polymerase chain reaction (PCR) testing of the IgHV gene affirmed a clonal connection between cHL and secondary DLBCL in one case, while the high morphological similarity suggested a potential clonality between the two lymphomas in another case. Conclusion This study reveals that secondary NHL may manifest both synchronously and sequentially following cHL. Our results suggest that synchronous NHL has a worse prognosis compared to sequential cases when the different lymphomas are not recognized at the time of diagnosis. As our data showed, in some cases, mutations that accompany the tumor cells throughout their clonal evolution can be identified, with additional mutations later on. In the future, next-generation sequencing (NGS)-based processing of liquid biopsy samples can overcome the limitations resulting from the spatial heterogeneity of lymphoid malignancies. Over the long term, this identification could lead to early patient selection and alternative treatment strategies, ultimately leading to improved prospects for cure.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

公众号